Research

Former Problem Marijuana Users Start Young, But Quit Young Too

When looking at those in recovery, problem marijuana users appear to start daily use at younger ages than problem alcohol or other drug users. That said, this study found that they also quit younger, and require less external supports to quit successfully.

WHAT PROBLEM DOES THIS STUDY ADDRESS?

Cannabis use is much more widespread than the formal diagnosis of cannabis use disorder (which only accounts for 30% of recent marijuana users). The decriminalization,medicalization, and increasing legalization, of cannabis use is leading to greater cannabis exposure in the population as well as problem use, and is increasing the perception that cannabis is not harmful. Daily cannabis use is likely to be less harmful than daily alcohol or other drug use, nevertheless there appears to be negative effects from heavy use on cognition, educational achievement and employment.

To understand the long-term impact of more widespread use on society and individuals struggling to quit, we can look to the 2.4 million Americans who have successfully quit after having a problem using marijuana. A representative sample from across the United States and from all types of households has shared the details of their marijuana, alcohol and other drug use, and the efforts that ultimately led to problem resolution. These data allow policy makers and the research community to more accurately understand when problem use begins, who is most vulnerable, how long it takes to overcome the problem, and what people use to help them overcome it.

HOW WAS THIS STUDY CONDUCTED?

Since it is based on the US Postal Service Delivery Sequence, it includes households without landlines or internet access. A representative subset of 40,000 individuals was surveyed between July and August 2016 with the screening question “Did you used to have a problem with alcohol or drugs but no longer do?”

Those who responded “yes” (just over 2000 individuals) were categorized as having resolved a substance problem, and then characterized in detail, with 12.6% of the group identifying their primary problem substance as cannabis, as compared with the 58.5% identifying alcohol and 28.9% identifying other substances (spanning illicit and prescribed substances, but excluding nicotine) as primary.

The detailed description of these three groups of individuals in recovery (primary problem use of cannabis, alcohol or other drugs) included assessing the onset of use, onset of problem use and time to recovery. The survey also included medical history, a legal history, and details about recovery supports and treatments used, as well as measures of psychological distress, quality of life, happiness and self-esteem.

WHAT DID THIS STUDY FIND?

Cannabis addiction careers are shorter:

Problem cannabis users who eventually resolve their cannabis use problem started using marijuana for the first time at the average age of 15, with regular use starting at an average of 17 years of age. Though problem drinkers also start drinking at around age 15, their regular use starts later, at an average age of 19. Those in recovery from other drugs started using those drugs later with regular use coming shortly thereafter (first use on average age 22; first regular use age 23). The average addiction career for problem cannabis users in this study was 12 years, as compared to those who recovered from alcohol use (average addiction career 19 years) and those with problematic use of other drugs (addiction career average of 9 years). However, cannabis problem users start young, and they also appear to resolve their problem at significantly younger ages than the other problem users (at average age 29 compared with 38 for problem alcohol users and 33 for other problem users).

Most recover without formal treatment:

It took an average of five attempts to quit problem use, with all three substance use groups (i.e., cannabis, alcohol, other drug) close to that average. The majority of those attempts, however, took place without formal treatment services, with cannabis users the least likely to access medical services or mutual help organizations (18% vs 42% for those with other primary substances). Of those seeking services, participants were more than twice as likely to have attended mutual help organizations (44%) as compared with outpatient treatment programs (17%), although former cannabis problem users had lower recent attendance at meetings than the other recovering users (an average of 2 meetings in the past 3 months as compared with an average of 8 meetings for recovering alcohol or other drug groups users). The recovering cannabis use group were significantly less likely to use outpatient services, had fewer episodes of outpatient treatment when accessed, and were much less likely to have had inpatient services. That being said, the recovering cannabis users who did access outpatient treatment were much more likely to have recovered more recently. This finding raises the possibility that outpatient treatment for cannabis use is now more accessible; or, possibly, that the more recent availability and use of higher potency marijuana means that more recent cannabis users are more likely to need external supports to stop using the drug.

Recovered users, on average, do not appear to be in psychological distress:

The survey participants, all of whom had problematic substance use that they no longer consider to be problematic, had low psychological distress scores (5 out of 24), and moderately high quality of life scores (3.7 out of 5), happiness scores (3.8 out of 5) and self-esteem scores (3.5 out of 5). The scores were similar across all of the substance use groups and the quality of life scores in this study appear similar to non-depressed individuals in the general population.

WHY IS THIS STUDY IMPORTANT?

This study looks in detail at the characteristics of individuals recovering from a variety of substance use problems and was carried out in a large nationally-representative sample of Americans. The cross-sectional sampling method used includes individuals from across all socio-economic strata of the United States population regardless of technological access and thus represents a much broader sample than that typically captured in academic studies. This study points to significant demographic differences between recovering from a cannabis use problem as compared with other substances and can help inform the age at which treatment services should be targeted.

The average age of problematic use of cannabis spans from the late teens to mid/late twenties, a time of life when they are particularly vulnerable to the neurological and intellectually blunting effects of cannabis. On average, problem cannabis users who recover are in their late twenties -five to ten years younger than other individuals whose primary substances are something other than cannabis. Problematic cannabis users seem able to recover while accessing less formal care and attending fewer mutual-help meetings on an on-going basis than other recovering problematic substance users. However, accessing care does correlate with more recent recovery from problematic cannabis use suggesting that the younger population is accessing care at higher rates than previously. The exact reason for this change cannot be determined from this study, but it could be from greater insurance coverage for SUD treatment, or greater impact of higher potency cannabis that is available nowadays which may have a bigger negative neurological impact that requires external supports to change.

In summary, problematic cannabis users start regular use and problematic use young (on average in their mid-to-late teens) but also recover from problematic use at a younger age (late 20s) despite having on average an addiction career spanning 12 years. The vast majority of those recovered did so without the help of formal treatment or mutual-help organizations. This study does not speak to whether recovery from problematic cannabis use is easier to accomplish than other forms of recovery or whether they would recover even sooner if they accessed treatment at the rates seen in other problematic substance use.

LIMITATIONS

This study consists of those who self-define as no longer having problematic substance use – a definition that is broader than the those only meeting criteria for a substance use disorder, but should include the latter.

This study is limited to those who identify as successfully in recovery so the characteristics of those not yet in recovery could represent vastly different demographics.

The survey done in 2016, looking only at those who have successfully resolved a significant drug problem, captures the increased availability and accessibility afforded by state-wide decriminalization and medical marijuana expansions but may not capture the effects of recreational marijuana legalization across an increasing number of states.

The survey captures a history of cannabis use across many decades and does not distinguish between mis-use of lower potency vs much higher potency cannabis. Combining these two groups may mask important differences in severity of use or difficulty of recovery.

The analysis of the association between accessing treatment for recovered cannabis users and the end of their addiction careers was done as a post-hoc analysis. Had it been initially included in the research design, the data analyzed may have yielded further insights into the role treatment plays in recovery from problematic cannabis use.

NEXT STEPS

In terms of population studies, it will be important to determine if the timeline of recovery from high-potency cannabis differs from cannabis use in aggregate. The sub-analysis of those accessing recovery services does suggest that recovery from the higher potency strains more readily available currently may require more treatment than recovery from less potent cannabis. This, however, needs to be confirmed in future studies. Furthermore, if this group of recovered problematic cannabis users did not generally access treatment or mutual help organizations, it is critical to understand what changes in their lives helped make recovery possible.

BOTTOM LINE

For individuals & families seeking recovery:Among those successfully resolving a cannabis problem, regular use appears to start sooner than for other drugs that are commonly misused, like alcohol, stimulants, or opioids. Given the known neurotoxic effects of cannabis on the developing brain, it is important to target adolescents in particular to help prevent regular or heavy exposure during this critical period.

For scientists: The need to understand whether stopping problematic cannabis use is becoming more difficult to accomplish is challenging given the new more potent strains. This study points to important differences in recovery from problematic use of marijuana vs alcohol or other drugs in terms of age of onset and engagement in treatment modalities. Future studies may need to focus on a younger population not connected to medical providers or mutual help organizations.

For policy makers: Increasingly, as access to cannabis is liberalized, the perception of harm caused by cannabis is being reduced so accurate data about the harm and the number of attempts it takes problem users to quit (comparable to other problem substances) is important. The average addiction career length of 12 years for problem cannabis users may come as a surprise to some policy makers.

For treatment professionals and treatment systems: On average, problem cannabis users who recover take 12 years and 5 attempts to do so. They also start regular use young (in mid-to-late teens) so starting treatment or interventions early may rescue their mid-20s in terms of focus on school or work.

**Note: One or more authors of this study were Recovery Research Institute Staff, including the director and/or other research scientists. As with all summaries, staff made the greatest possible effort to recognize and account for any potential biases in the review of this article.

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